Bradycardia and

Conduction Delay
Fera Hidayati
Impulse Propagation
Bradycardia

• Heart rate < 60 bpm in adults other than well trained athletes
• Population studies : use a lower cut off of 50 bpm

• Classification of bradycardia :
✓ Sinus node dysfunction :
✓ AV node dysfunction

• Bradycardia → cardiac output ↓ → perfusion ↓ → symptoms

Signs and symptom

• Asymptomatic → progressive
• Near-fainting spells or syncope
• Transient lightheadedness
• Confusion, fatigue, palpitations, angina, congestive
• Heart failure, stroke, transient ischemic attacks, vague
• Gastrointestinal symptoms, or oliguria.
 Diagnosis

• Presence of ECG abnormalities and clinical symptoms

• Some times need ambulatory cardiac monitoring

devices, depend on symptoms frequency
Classification of Bradyarrhythmias Based on
The Patient’s Clinical Presentation

Kusumoto et al., 2018

 Sinus node dysfunction (SND)

• Age-dependent progressive fibrosis of the sinus nodal

tissue and surrounding atrial myocardium
• Abnormalities of sinus node and atrial impulse
formation and propagation
• No established minimum heart rate or pause duration
where permanent pacing is recommended;
• establishing temporal correlation between symptoms
and bradycardia is important when deciding on the
necessity of permanent pacing.

Kusumoto et al., 2018

Definition of Sinus node dysfunction (SND)

Kusumoto et al., 2018

Sinus Bradikardi

Ectopic Atrial Bradikardi

Sinus Pause

Tachycardi-Bradycardi Syndrome
Isorhytmic Dissociation
Definition of Atrioventricular Block (1)

Kusumoto et al., 2018

Definition of Atrioventricular Block (2)

Kusumoto et al., 2018

Atrioventricular Block
Atrioventricular
Block
Conduction Delay
Right Bundle Branch Block
Right Bundle Branch Block
Left Bundle Branch Block
Left Bundle Branch Block
 Conduction Tissue Disease
• Nonspecific intraventricular conduction delay (as defined in adults):
QRS duration >110 ms where morphology criteria for RBBB or LBBB are not
present
• Left anterior fascicular block:
1. QRS duration <120 ms
2. Frontal plane axis between −45° and −90°
3. qR (small r, tall R) pattern in lead aVL
4. R-peak time in lead aVL of ≥45 ms
5. rS pattern (small r, deep S) in leads II, III, and aVF
• Left posterior fascicular block:
1. QRS duration <120 ms
2. Frontal plane axis between 90° and 180° in adults.
3. rS (small r, deep S) pattern in leads I and aVL
4. qR (small q, tall R) pattern in leads III and aVF
Left Anterior Fascicular Block (LAFB)
Left Posterior Fascicular Block (LPFB)
Management
Evaluation of Bradycardia and Conduction Disease
Initial Evaluation of Suspected or Documented SND Algorithm
Initial Evaluation of Suspected Atrioventricular Block Algorithm
Chronic SND Management Algorithm
Management of Bradycardia or Pauses Attributable to
Chronic Atrioventricular Block Algorithm
-Matur Nuwun-
Impulse Propagation